Failure analysis of a broken tooth

Several days after heart surgery, a patient discovered his upper right canine tooth had broken at the root. Such tooth damage, recognized post-operatively, is usually assumed to be caused by blunt mechanical force from an instrument used by the anesthesiologist during placement of a breathing tube at the start of surgery. In this case, the patient had saved the crown portion of the broken tooth, and it was possible to examine the root fracture characteristics. The curvature and direction of the crack path and natural tooth situation suggested that failure could be described through a cantilever beam model. This was confirmed when a whole extracted sample tooth was embedded and broken by a measured force in a manner consistent with the model. The resulting fracture surface matched that of the patient’s broken canine tooth. However, the high load and force direction necessary to fracture the root was inconsistent with forces applied during the anesthesia procedure. The failure analysis and further investigation indicated tooth clenching on the breathing tube during recovery was the likely cause of fracture. This paper presents an alternate explanation for intubation-related dental injury, demonstrates the practicality of fractographic analysis of biological materials, and introduces a methodology for simulating in vitro tooth settings for mechanical testing.